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Client and
Doctor Communication
One of the great ironies in seeking medical care is that often
we are required to make an appointment from one to several months
in advance, meaning we must have pre-cognition of our upcoming needs.
Then, so as not to miss that appointment and start again from scratch,
we must plan ahead to be well enough to make it in when our appointment
finally comes due. Unfortunately, few of us possess crystal balls,
which can make such preplanning psychically challenging at best.
If we're fortunate to be able to keep our appointments, we may
still be unlucky enough to be in an Health Maintenance Organization,
with more hoops to jump through than a poodle in the circus. For
instance, some HMO's only authorize one 15 minute visit for each
new client and only an 8 minute visit each for regular clients.
Affiliated with an HMO or not, many doctors are now so heavily scheduled
that they spend little or no time on discussion of our conditions,
current circumstances or providing us with information on the prescribed
medicines. Some quickly turn away, brushing us off with a smile
that'd do the Cheshire Cat proud and, like that elusive feline,
leave us dazed as they vanish into the ozone.
If we're seeing a physician only every few months or so, our medical
records will be his or her only divining tool but if he/she doesn't
remember us, how can we be sure those records are accurate or even
actually our own? Doctors' files are often updated hurriedly while
on the run between appointments then edited and entered into the
record later, when memory isn't fresh. For any number of reasons,
omissions and errors are reported to be far more common than we
might suspect. If our doctors seem to be befuddled, uninformed or
evasive, it may indicate that the records relied on are altered,
lost or not even ours. With a doctor who doesn't know us well, it's
always a good idea to reestablish in each visit just who we are,
the condition under treatment, the date of our last visit and the
results of that appointment.
The first visit with a new doctor is the ideal time to request
ongoing copies of our medical records, appropriately updated after
each appointment. With this procedure clear in our doctors' minds
and duly entered into our records the office will be more likely
to provide us with prompt updates soon after each visit. If we then
study each record update as we receive it, making any necessary
corrections and adding essential information, errors will be quickly
caught and our medical histories will be far more assured of accuracy.
Modern doctors are not only heavily scheduled but with HMO and/or
governmental regulations continually added or rewritten, the paperwork
required of medical offices can decimate a rainforest. Our primary
care physicians may find it difficult to keep up with research related
to our specific medical needs. Even specialists, whose job description
mandates they stay educated and informed could well be lagging behind.
According to recent U.S. Medicare breast cancer data, 48 % of women
living in Ohio received lumpectomies instead of mastectomies while
in South Dakota, only 1.4 % of women were offered the recommended
lumpectomy option. A study at The University of California, Los
Angeles reveals that 70 % of hysterectomies done over a period of
two years were unnecessary
It may help if we choose doctors affiliated with major medical
centers, where expectations of accountability and professionalism
are often higher and results more closely monitored. Still, the
surest way to have realistic assurance that current changes in research
and treatment are known and applied is to follow that research ourselves,
record pertinent information in our medical journals and share it
with our doctors. When they realize that we're well versed in our
condition, our doctors are more motivated to stay current in their
own studies.
Unfortunately, any doctor can claim to be a board certified specialist,
whether or not he/she is actually certified in their chosen field.
This blurring of distinction is especially prevalent in plastic
surgery but can have serious ramifications for us all. To protect
our interests and be sure our doctors are board certified to diagnose
and treat our conditions, in the U.S. at least, we can call the
American Board of Medical Specialties at 800-776-2378. Misrepresentation
becomes more common as certain fields become more lucrative so it's
always wise to be sure just who we're dealing with and how qualified
they truly are.
Waiting for our test results can create nail-nibbling anxiety and
the best way to impress our physicians with a sense of urgency is
to request our notification within a specified time period. The
American Food and Drug Administration, for instance, mandates that
mammography clients be notified within approximately five business
days of suspicious results but if the test is related to a serious
or urgent concern three days is preferred. Many labs send written
test results directly to clients (though some do so only upon request)
and our doctors should also comply. We'd be wise to demand an informative
explanation of any implications and re-testing if those results
don't add up. Test results can easily be incorrect as in the notorious
ANA test for Lupus so if we're dissatisfied we should insist that
our complete symptoms and medical history be accorded equal weight.
Medicine is now a profit-driven profession and if one doctor doesn't
value our input, we can bet another will.
Once we have reliable test results and treatment is about to begin,
we must traverse the medication minefield. Nowdays, medications
are widely and temptingly promoted but those drugs' side effects
and dangerous interactions are soft-pedaled. Some of these medications
may indeed be beneficial but ad campaigns aren't informative enough
to verify those possibilities. For example, steroids used in the
treatment of Lupus are meant to be taken for short periods, with
substitutions if needed and "breathers' to minimize side-effects.
Rezulin, prescribed for diabetes, necessitates monthly testing for
liver damage but the FDA has found U.S. doctors monitoring only
1 in 10 clients.
Over 11,000 medications are now marketed and some studies state
that many doctors prescribe based on habit or drug company persuasion.
At least in the U.S., federal law demands pharmacists offer full
information on request and no matter where we live, our doctors
and pharmacists should be willing to inform us. Prescription information
is very brief and when the labels direct dosage, "every 4 hours",
we need to be positive whether that means we'll have to take a pill
in the middle of the night. We should know if a missed pill means
doubling up or waiting until the next dose is due, a factor that
varies frequently.
When we discuss our medications with our doctors we can question
their experience in prescribing them for our conditions. Knowing
if they've done so for similar clients, how often and to what effect
is very important. Many drugs have substitutes which might be more
helpful so it's best to discuss any alternatives. If we encounter
any adverse effects, we should immediately document them, report
them to our doctor and be positive they appear in our medical record.
We can request drug package inserts from our doctors or pharmacists
(the nastiest warnings are often in a black box) and check out the
Physicians' Desk Reference at the library or visit PDR online at:
http://www.pdr.net/ looking up contraindications plus drug and food
interactions.
If surgery becomes necessary, studies show that we're better off
with doctors who perform that particular operation often and to
good outcome. The medical journal "Circulation" has published a
study on the results of 13,000 angioplasties which found that surgeons
who performed fewer than 70 yearly had complication rates averaging
9.3 % while those who did over 270 had only a 2.9 % complication
average. It's completely acceptable to ask not only our doctors'
success ratio but their failure rate too. All possible risk factors
should be clearly explained and no surgery should proceed without
concise and cogent answers. As we're wheeled into pre-op the last
question on our minds should be, "who is that masked man", especially
without faithful Tonto nearby to run to the rescue.
Although it's now widely acknowledged that lifestyle has a tremendous
impact on health and immunological reactions, with brief, sparsely
spaced appointments and our doctors in a dizzying rush, there may
not be time or inclination to talk about our daily lives. A study
by The Center for Disease Control and Prevention has shown that
in 29,000 office visits, only 23% of clients received counseling
on diet, only 19% on exercise and 10% on weight problems, even if
obesity or anorexia was an issue of client concern. If necessary,
we might schedule one appointment just for the opportunity to focus
on these crucial issues
There are many repositories cataloguing current medical research
online, including The Colorado Health Site at: http://www.coloradohealthnet.org/
National Jewish Medical Center is the only U.S. medical/research
center entirely devoted to respiratory and immune disorders with
an exceptional website at: http://nationaljewish.org/main.html and
Lupus pages found at:http://www.nationaljewish.org/medfacts/systemic.html
Medline's home page is at: http://medlineplus.gov/ with an extensive
Lupus library at: http://www.nlm.nih.gov/medlineplus/lupus.html
The National Institute of Health at: http://www.nih.gov/ has a search
engine with excellent Lupus pages as does M.D. Choice at: http://www.mdchoice.com/
and Health On The Net at: http://www.hon.ch/
Our doctors are reimbursed for their services, by us, Social Security
Insurance or by other insurance companies and in any other business
this defines us as clients. If we think of ourselves as "patients",
patience may be all that's ever expected of us. Our health is too
vitally important for us to wait silently like wallflowers at the
dance until our doctors take the first step forward. No question
is ever unimportant; whatever concerns us should concern our physicians
and merit discussion. This life is not a dress rehearsal and we
can't always wait around for the second act.
Researched. written and copyrighted by Shar Phoenix [email protected]
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Butterfly News Copyright The Lupus Site 2001 www.uklupus.co.uk
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